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Strategies for Alleviating Musculoskeletal Pain in the Emergency Department

Tips for your Emergency Medicine colleagues helping patients with musculoskeletal injuries get off to a good start.

Pain is the most common symptom presenting in the emergency department (ED)—either acute pain due to trauma or worsening of chronic pain.1 It is important for ED teams to establish consensus protocols and policies to control and limit opioid prescription and inappropriate use.2 Consensus strategies can help to depersonalize decisions made about opioid use and defuse potentially difficult discussions with patients about opioid prescriptions to manage acute musculoskeletal pain.

Consensus opioid strategies might include3,4:

  • Identification of the providers responsible for managing pain and prescribing opioids
  • Coordination with that provider
  • Setting ranges for acceptable amounts of opioids
  • Determining strict upper limits on opioid prescription size and strength
  • No prescribing of extended-release opioids for musculoskeletal pain by emergency department clinicians
  • Encouraging patients to use nonpharmacologic pain management, acetaminophen, and NSAIDs
  • Using tools to identify patients at risk of opioid dependence
  • If opioids are prescribed, counseling patients on the risks and serious adverse effects of opioids and their safe storage and disposal.
  • Checking statewide databases to see when/if patient has filled recent opioid prescriptions and if they have been seeing multiple providers.
  • Using scripts and practicing empathetic and effective communication strategies geared toward all levels of health literacy
  • Identifying opportunities for emotional and social support
  • Supporting quality improvement initiatives and continuing medical education for safe and effective alleviation of pain and optimal opioid stewardship. 

Click here to see an example of an Opioid Safety Strategy for an Emergency Department.

 

1. Todd, KH. A review of current and emerging approaches to pain management in the emergency department. Pain Ther. 2017;6(2):193-202. 2. Motov S, et al. The treatment of acute pain in the emergency department: a white paper position statement prepared for the American Academy of Emergency Medicine. J Emerg Med. 2018;54(5):731-736. 3. American Academy of Orthopaedic Surgeons. Information statement: Opioid use, misuse, and abuse in orthopaedic practice. https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1045%20Opioid%20Use,%20Misuse,%20and%20Abuse%20in%20Practice.pdf. Accessed August 14, 2108. 4. American College of Emergency Physicians. Policy Statement: Optimizing the treatment of acute pain in the emergency department. https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/supported-statements/optimizing-the-treatment-of-acute-pain-in-the-ed.pdf?sfvrsn=4e5c71e_4.